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EUBUCiiSALTH 


State  Boards  of  Health, 


THEIR   OBJECT  AND    USE.   ETC. 


..T.rOR  -^ 

KXTRACT8,  SHOWING  THE  '  ' 


VIEWS  OF  PRACTICAL  WORKERS  AND  EMINENT  SANITARIANS. 


ISSUED   BY   OKDEE  OF   THB 


INDIANA   STATE   BOARD   OF   HEALTH. 


THAD.  M./STEVENS,  M.   D., 
Secretary  h'nU  JUxecutive^jJicer. 


INDIANAPOLIS: 

W.M.    n.    BUKFiiKO,    PRINTEn,    LITHOGRAPHJER   AMD    BIN  OKU 


fubiic  Health  lib." 


PUBUC 
HEALTH 
LIBRARY 


OPINIONS   OF   SANITARIANS. 


The  first  State  Board  of  Health  in  the  United  States  was  that 
of  Massachusetts,  established  in  1869.  Since  that  date,  twenty- 
six  States  have  established  health  organizations.  By  an  act,  ap- 
proved March  7, 1881,  a  State  Board  was  established  in  Indiana, 
and  since  that  date,  there  has  been  fully  organized  in  every 
eounty  of  the  State,  except  one,  a  County  Health  Board;  also, 
city  and  town  boards  in  each  incorporated  city  and  town  of 
the  State. 

Such  organization  necessarily  entails  some  expense,  and 
places  upon  physicians  and  others  certain  duties,  for  the  per- 
formance of  which  they  do  not  receive  what  would  appear  to 
be  adequate  pay. 

It  is  the  duty  of  those  engaged  in  such  work,  or  taking  an 
interest  therein,  to  inform  those  who  seek  information  relative 
to  the  value  of  such  work,  and  to  show  the  need  and  good 
policy  of  keeping  up  the  added  expense  to  the  State  and  in- 
creased labor  that  devolves  upon  the  physicians  and  others. 

"We  here  present  the  views  of  many  who  have  for  years  been 
engaged  in  such  work,  and  give,  also,  the  recorded  result,  so 
that  all  may  easily  judge  of  its  value  and  need. 

The  introduction  of  any  new  system  is  generally  met  with 
more  or  less  opposition,  and  it  was  not  to  be  expected  that  the 
establishment  of  a  State  Board  of  Health  would  be  an  excep- 
tion. It  is  gratifying  to  know  that  this  opposition  has  been 
less  than  was  anticipated.  The  cause  of  opposition  may  be 
said  to  be  founded  on  a  misapprehension  or  ignorance  of  the 
object  of  the  law  and  the  aims  of  the  Board. 

It  may  be  well  to  state  that  the  chief  aim  of  the  law  is,  first, 
to  collect  facts  and  then  to  disseminate  correct  sanitary  infor- 

ivi833990 


matioii  among  tlie  people.  Wliatcvcr  tends  to  increase  tlie 
knowledge  of  the  medical  profession,  tends  to  increase  the 
Bufety  and  health  of  the  people.  It  i^-  due  the  medical  profes- 
sion to  say  that  its  members  have  generally  been  eager  to  seek 
all  information  that  promises  any  beneficial  knowledge,  and  the 
si'.iiitary  and  vital  facts,  gathered  by  the  State  and  local  Boards, 
will  furnish  data  from  which  we  shall  be  able  to. arrive  at  cor- 
rect conclusions,  as  to  tlie  causes  and  means  of  prevention  of 
many  diseases. 

The  graveyards  of  the  State  are  full  of  those  w1io  have  fallen 
victims  to  their  own  lack  of  knowledge,  or  their  own  careless- 
ness. It  is  within  the  bounds  of  truth  to  say  that  two-thirds 
of  the  children  that  die  annually,  iii  Indianapolis  or  other  cities 
of  the  State,  might  have  been  rescued  from  death,  had  their 
parents  possessed  the  information  which  should  be  within  the 
reach  of  all.  Not  by  means  of  any  "Domestic*  Medicine,"  or 
"Every  Man  His  Own  I'hysician"  book,  but  by  well  authenti- 
cated and  practical  facts,  placed  before  the  people  in  a  reliable- 
shape,  so  that  they  should  be  warned  as  to  the  dangers  that 
can  be  avoided,  as  the  red  flag,  warns  of  small-pox  or  the 
signal  light,  of  the  locomotive.  Such  disseminated  intelligence 
would  furnish  the  means  of  avoiding  the  danger. 

Take  that  disease  so  common  among  children,  viz :  Whooping 
cough — parents  look  upon  it  as  one  of  the  necessar}'  ills  that 
must  fall  upon  all  children,  and  regard  it  as  being  without 
danger  to  the  child,  and  in  many  cases  hail  its  appearance  with 
a  kind  of  semi-delight.  It  is  true,  there  is  comparatively  little 
danger  in  the  disease,  if  proper  care  is  taken  of  the  child,  and 
this  care  must  be  exercised  by  the  parents,  and  not  by  the 
medical  attendant,  if  there  be  one.  The  truth  must  be  made 
known  to  the  people.  Scarlet  fever  is  justly  regarded  with 
dread,  yet  whooping  cough  has  annually,  in  Indiana,  carried  to 
the  grave  more  victims  than  scarlet  fever,  and  while  the  Board 
has  at  present  no  means  of  knowing  the  exact  facts  in  every 
case,  yet  the  information  it  has,  justifies  it  in  saying  that  in 
nearly  all  cases  of  death  from  whooping  cough  during  the  past 
nine  months,  the  fact  that  death  ensued  was  due  to  want  ot 
proper  care  of  the  child  by  its  parent  or  nurse,  especially  at  a 
time  when  the  patient  is  supposed  to  be  convalescent. 

Diphtheria  is  another  of  those  diseases  that  has  caused  fearful 


ravages  among  children.  Statistics, gathered  by  the  Board,  show 
that  certain  diseases  are  prevalent  with  this  class  of  the  popula- 
tion. This  is  not  always  from  anything  in  their  occupation  or 
surroundings.  The  causes  for  the  frequency  of  death  must  often 
he  sought  for  elsewhere.  A  study  of  the  tables  compiled  by  the 
State  Board,  that  will  appear  in  the  annual  report,  will  show 
that  bronchitis  and  pneumonia  are  particularly  noticeable  for  the 
fatal  ending  in  cases  of  children,  and  this  frequently  is,  in  a 
large  degree,  due  to  a  want  of  proper  preventive  measures. 

Farmers  and  their  families  will,  in  winter,  attend  p'atherins^s 
of  various  kinds  in  small  and  ill-ve7itii;ited  school  houses-  or 
churches;  stoves  are  made  red  hot,  and,  from  the  steaming  at- 
mosphere, they  go  forth  into  the  chilling  air — ride  home  through 
the  cold  without  properly  protecting  themselves. 

In  the  city,  those  who  attend  such  assemblages  go,  at  least, 
provided  with*  wraps  to  protect  themselves  against  such  sudden 
changes,  and  the  result  is,  they  are  less  liable  to  those  forms  of 
disease. 

It  is  safe  to  say  that  one  hundred  persons  are  annually  killed 
upon  and  by  railroads  of  the  State,  and  that,  of  tlie  whole  num- 
ber, less  than  a  score  are  employes  of  the  railroad,  while  the 
other  persons  are  those  who  have  no  business  in  the  place  where 
they  meet  their  death.  It  is  only  bringing  such  facts  to  the 
minds  of  the  people  that  they  can  be  made  to  realize  their 
danger.  They  hear  of  isolated  cases  of  railroad  injuries,  but 
it  is  the  figures  in  the  aggregate  that  impress  them. 

In  accidents,  of  one  kind  and  another,  fully  five  hundred 
persons,  annually,  in  Indiana,  meet  their  death,  and,  in  nine 
cases  out  of  ten,  carelessness  somewhere  is  the  cause. 

It  may  be  asked,  why  the  State  should  engage  in  the  work? 
The  State  is  directly  interested  in  the  life  and  health  of  every 
citizen.  The  longer  lived  and  healthier  its  citizens,  the  stronger 
and  wealthier  the  State  becomes. 

As  to  vaccination,  the  policy  of  compulsory  vaccination  has 
been  very  much  questioned,  and  the  silly  objection  that  such  a 
system  interferes  with  the  rights  of  the  citizen,  has  been  made. 
Every  citizen  owes  some  obligation  to  the  community  where  he 
lives,  and  while  he  may  have  an  abstract  right  to  deal  with  his 
own  life,  he  has  no  right  to  endanger  the  life  or  health  of  an- 
other. 


G 

Vaccination  is  not  alone  to  preBcrvc  one  from  the  disease, 
but  also  to  prevent  him  from  aiding  in  its  dissemination  among 
liis  fclIow.H. 

The  prevention  of  disease  is  the  accumulation  of  wealth  botli 
to  the  individual  and  the  State.  The  knowledge  how  to  j)reventy 
is  based  upon  ihtal  and  sanitary  statistics. 

The  diseases  that  are  of  the  most  importance  in  a  sanitary 
point  of  view  belong  to  the  class  Zymotic  (ferments).  We  may 
mention,  as  prominent  among  these,  the  following,  viz:  Small- 
pox, diphtheria,  ncarlct  fever,  chicken-pox,  wliooping  cough, 
typhoid  and  typhus  fever,  puerperal  fever,  croup,  cerebro-spinal 
meningitis  and  cholera,  dysentery,  consumption  and  acute  lung 
affections  might  be  added. 

Xow  let  us  see  what  some  of  the  most  eminent  "and  practical 
sanitarians  sa}'  as  to  the  influence  upon  human  health  and  com- 
fort the  work  of  State  and  local  health  organizations  exert,  and 
as  to  the  value  of  vital  and  sanitary  statistics.  We  give  the 
following  extracts: 

PuiJLic  Economy  of  Sanitary  xVIea-^lires. 

We  are  fast  coming  to  understand  that  the  prevention  of  dis- 
ease means  wealth  and  prosperity,  and  that,  aside  from  those 
high  and  sacred  considerations  which  move  the  heart  of  man 
to  alleviate  the  sutterings  and  obstruct  the  evils  that  afflict  his 
fellow-man,  there  is  a  sharp  pecuniary  side  to  your  efforts, 
which,  as  true  citizens  of  Chicago,  we  are  not  at  liberty  to 
overlook. 

I  read  in  o)ie  of  your  interesting  re])orts  that  the  small-pox 
scourge  of  1871-72,  cost  the  city  of  Pliiladelphia  over  twenty- 
one  million  dollars.  The  facts  given,  I  think,  warrant  the 
conclusion.  This  was  manifested  in  diminished  travel  and 
shrunken  commerce.  Nor  is  this  all;  for  it  appears  that  this 
great  sum  might  have  been  saved,  to  say  nothing  of  the  lives 
lost  and  the  suffering  endured.  We  rejoice  this  year  in  a  most 
bountiful  crop;  but  thei'c  are  other  sources  of  wealth,  quite  as 
visible  and  more  certain  than  corn  ami  wheat,  that  do  not 
attract  our  attention. 

Our  city  has  been  in  commotion  for  thirty  days  about  the 
truly  serious  loss  of  four  or  five  million  dollars  by  our  savings 


banks,  but  we  probably  annually  lose  a  much  greater  sum  in, 
and  inclitference  to,  sanitary  means,  and  without  excitement 
and  almost  without  protest. 

There  is  not  within  the  limits  of  Chicago  a  business  unin- 
jured, a  palatial  residence  or  a  cottage,  the  value  of  Avhich  is 
not  diminished  by  the  pestilent  odors  that  sweep  over  the  city. 
Yet  men,  busy  with  their  own  afiairs,  who  pass  for  sagacious, 
far-seeing  men,  act  as  though  it  were  no  concern  of  theirs — no 
concern  of  theirs  as  to  the  drainage  of  houses  two  blocks  away; 
no  concern  of  theirs  whether  the  air,  common  to  all,  becomes 
polluted;  but  typhoid  and  scarlet  fever  among  their  loved  ones 
at  home  utter  a  mournful  denial  of  these  assertions.  And  thus 
you  will  prove  that  the  widest  traffic,  the  most  permanent  pros- 
perity, and  the  largest  security  for  the  home  are  founded  on 
the  truth  that  man  is  his  brother's  keeper. 

"Wirt  Dexter,  Esq. 
A.  P.  H.  A.  Beport,  Vol  IV. 


Possible  Future  Achievements  in  Hygiene. 

Let  us  now  inquire  what  are  some  of  the  possible  achieve- 
ments of  hygienic  science  and  art  in  the  future,  and  the  best 
means  for  their  accomplishment. 

One  of  the  most  promising  fields  of  labor  for  the  hygienist 
is,  it  seems  to  me,  in  the  still  further  prevention  of  sickness 
and  deaths  from  miasmatic  causes. 

Referring  to  our  vital  statistics  for  1871,  we  learn  that  the 
probable  number  of  deaths  in  the  State,  as  corrected  by  the 
compiler,  was  18,094,  and  that  of  these  4,832,  or  about  27  per 
cent.,  were  believed  to  have  been  caused  by  miasmatic  diseases. 
Certainly  this  number  should  be  largely  increased,  for  there 
were  reported  as  deaths  from  pneumonia,  482 ;  or,  when  "  cor- 
rected "  by  multiplying  by  1.86,  800.  Of  these  we  may  add  to 
our  former  number  of  deaths  from  miasmatic  causes  at  least 
500,  as  surely  due  to  miasmatic  causes  as  any  others,  and  we 
have  our  list  swelled  to  5,332  from  these  causes  in  a  single  year. 

As  many  persons  can  better  appreciate  the  loss  to  the  State 
by  preventable  deaths  when  the  value  of  the  years  of  "eftective 


8 

life"  lost  by  thorn  i.s  put  into  dollars  and  conU,  let  uh,  for  a, 
moment  try,  approximately,  to  estimate  the  real  money  loss  to 
the  State  by  these  miasmatic  causes. 

The  last  sickness  of  tlie  5,332  persons  who  die  from  these 
causes,  including  loss  of  time,  must  have  cost  on  an  average  $50 
for  each  person,  and  the  funeral  expenses  must  have  been,  on 
an  average,  §25  for  each  one,  giving  a  cost — actually  a  loss — 
to  the  State  of  ^399,900. 

Now,  as  these  causes  of  death  are  accounted  by  all  hygicnists 
as  preventable,  it  is  safe  to  say  that  a  large  number  of  these 
persons  died  prematurely.  Let  us  suppose,  then,  that  these 
persons  died  sooner  than  they  otherwise  would  by  an  average 
of  ten  years,  and  that  one-half  of -those  years  thus  lost  might 
be  said  to  be  years  of ''  eiiective  life." 

The  State  then  loses,  annually,  26,660  years  of  "effective  life,"' 
which  can  not  be  estimated  at  less  than  >?150  per  year,  giving  a 
money  loss  of  $3,999,000. 

English  observers  and  statisticians  have  estimated  that  for 
every  death  two  persons  are  constantly  sick. 

Thus  for  every  death  from  the  same  causes  under  cousidera- 
tion,  it  is  probable  there  are  two  years  of  sickness  from  the 
same  causes  in  other  persons  in  this  State,  or  10,664  years  of 
sickness  from  miasmatic  causes  in  the  year  1871.  Counting 
one-half  of  these  years  of  sickness  as  in  the  "effective  period" 
of  life,  we  have  their  money  value,  §150  per  year,  §799,800, 
which  is  really  so  much  loss  to  the  State. 

Nor  is  this  all ;  for  the  cost  of  these  10,664  years  of  sickness, 
in  medical  attendance,  nursing  and  loss  of  time  of  parents  and 
friends  can  not  be  estimated  at  less  than  an  average  of  §200  per 
year,  thus  entailing  another  loss  to  the  State  of  §2,132,800. 
Here,  theu,  is  the  approximate  money  loss  to  the  State  from 
these  preventable  causes  of  sickness  and  death  : 

Sickness  and  funeral  expenses  of  those  dead  from 

these  causes,  5,332 §399,900 

Loss  of  effective  years  of  labor  bv  these  premature 

deaths,  26,660 '... • 3,999,000 

Loss  of  effective  years   of   labor  from   sickness  of 

others,  5,332  years 799,800 

Loss  in  cost  of  10,664  years  of  sickness 2,132,800 

Total  loss  to  the  State §7,331,500 


9 

That  probably  one-half  of  all  this  loss  may  be  saved  to  the 
State  is,  I  think,  apparent  from  the  foUowine^  and  other  con- 
siderations: 

Dr.  Edward  Jarvis,  in  a  paper  contributed  to  the  State  Board 
of  Health  of  Massachusetts,  on  "Political  Economy  of  Health," 
very  concisely  remarks  that  "the  cftective  power  of  a  nation  is 
in  the  number  of  its  people  in  sustaining  period"  {i.  e.,  between 
the  ages  of  twenty  and  seventy),  "and  in  the  proportion  these 
bear  to  the  dependent  classes." 

"Collective  personal  gain  is  public  gain,  and  aggregate  per- 
sonal loss  is,  to  the  same  extent,  the  suffering  of  the  com- 
munity." 

"  The  S.tate  thus  has  an  interest  not  only  in  the  prosperity,  but 
also  in  the  health  and  strength  and  eiiective  power  of  each  one 
of  its  members." 

Whatever  has,  in  the  history  of  the  race,  and  especially  in 
the  history  of  civilization,  intended  to  add  to  the  efficient  power 
of  individuals  of  the  various  nations,  is  really  embraced  in 
hygienic  science  and  art.  Their's  are  the  better  adaptations 
of  means,  circumstances,  and  habits,  by  which  man's' life  has 
been  expanded  and  his  strength  increased;  their's  the  various 
improvements  in  agriculture,  in  vegetable  and  animal  life,  by 
which  man  has  obtained  better  and  more  constant  food;  their's, 
too,  the  wonderful  and  manifold  improvements  in  the  arts,  by 
w^hich  man  is  better  clothed  and  housed. 

The  gradual  increase  in  the  length  of  human  life  since  the 
commencement  of  the  Christian  era,  is  the  result,  and  really 
marks  the  progress  of  the  benignant  rule  of  the  goddess  Hygea. 

In  the  third  century,  the  average  duration  of  life  among  the 
most  favored  classes  in  ancient  Rome  was  thirty  years.  In  the 
present  century,  the  average  longevity  ot  persons  of  the  same 
class  is  fifty  years,  or  an  increase  since  the  third  century  of  67 
per  cent.  There  can,  I  think,  be  no  doubt  that  in  "the  lower 
classes  the  increased  longevity  is  still  more  striking. 

II,  O.  HiTcncocK,  M.  I). 
MicUyan  Ecport,  1876. 


10 

Responsibilitv  of  Board?  of  Health. 

While  the  responsibilities  of  Boards  of  Plealth  in  cities  and 
villages  are  proportionately  greater  than  in  the  townships,  yet 
the  importance  of  organization  and  careful  attention  to  the 
sanitary  conditio)is  of  tlie  town  must  not  be  underrated.  Epi- 
demics sometimes  sweep  through  a  farming  community,  which 
might  easily  have  been  prevented  by  prompt  action  on  the  part 
of  the  Board  of  Health,  had  immediate  notice  of  the  first  case 
been  given  to  them.  Nuisances  in  the  shape  of  stagnant  pools 
of  water  or  undraincd  marshes  often  exist  in  the  township, 
which  are  fruitful  sources  of  disease  to  the  inhabitants,  and 
should  be  abated  in  the  manner  prcrvided  by  law.  All  Boards 
of  Health  should,  therefore,  ascertain  whether  any  cause  of  dis- 
ease exists  within  their  jurisdiction,  and  if  there  is  reason  to 
apprehend  that  any  source  of  sickness  may  possibly  arise  from 
the  action  or  neglect  of  any  person,  the  Board  should  establish 
such  regulations,  and  take  such  measures  as  they  may  think 
necessary  to  prevent  the  same. 

Hon.  Leroy  Parker. 

Michigan  Report,  1870. 

The  statute  now  gives  the  State  Board  of  Health  only  direct- 
ory or  advisory  power.  Practical  experience  has  demonstrated 
the  necessity  for  giving  the  rules  and  orders  of  the  State  Board 
mandatory  power,  with  statutory  force  and  effect. 

Contingencies  have  arisen,  and  will  arise,  where  local  influ- 
ences prevent  the  operation  of  the  health  laws  for  the  protec- 
tion of  the  people.  Authority  should  rest  somewhere  in  such 
cases,  to  secure  to  communities  the  full  benefit  of  the  law,  and 
no  where  could  it  be  vested  with  more  impartial  judgment  than 
with  the  State  Board  of  Health,  composed,  as  it  is,  of  repre- 
sentatives from  difiorent  parts  of  the  State. 

Emergencies  often  exist  requiring  prompt  and  immediate  ac- 
tion to  })rotecf  the  public  health.  Boards  of  Health  should, 
therefore,  iiave  the  power  to  restrain  persons  from  maintaining 
a  nuisance  until  a  hearing  can  be  had  before  a  court.  Such  is 
the  law  in  Massachusetts,  and  the  Supreme  Court  of  that  State 
has  confirmed  the  action  of  Boards  of  Health  under  the  statute 
granting  such  powers. 

loica  Report y  1881. 


11 

Work  of  Health  Boards. 

As  regards  villages,  the  case  is  worse  than  in  cities.  Out  of 
152  incorporated  villages,  an  annual  report  for  the  year  ending 
September  30,  1874,  has  been  received  from  only  nine  clerks. 
There  seems  to  be  a  greater  degree  of  indifference  to  all  laws 
and  measures  for  promoting  the  public  health  in  villages,  than 
in  either  cities  or  townships;  and  this  is  particularly  unfortu- 
nate, because  it  is  in  just  such  places  that  so  much  can  be  done 
in  the  way  of  preventing  sickness  and  death.  It  is  in  villages- 
that  water  supply  is  peculiarly  liable  to  be  contaminated,  and 
the  inhabitants  to  be  decimated  in  consequence,  though  such 
diseases  as  diarrhea,  dysentery  and  typhoid  fever.  It  is  in  vil- 
lages that  the  ordinary  contagious  diseases  spread  with  such 
facility  and  rapidity,  through  the  free  communication  of  chil- 
dren. It  is  in  villages  that  that  fearful  disease,  cerebro-spinal 
meningitis,  or  spotted  fever,  most  frequently  causes  the  greatest 
destruction  of  life.  If  every  village  had  an  actual  and  active 
Board  of  Health,  how  much  might  be  done  to  search  out  and 
remove  some  of  these  causes  of  sickness  and  death  which  now 
strike  down  hundreds  from  the  village  population  of  this  State 
in  every  year. 

It  is  possible  that  some  part  of  this  apparent  inditterence 
really  comes  from  comparative  ignorance  of  the  subject,  both 
as  regards  the  possibility  of  preventing  sickness  and  death 
through  sanitary  work,  and  of  the  duties  of  village  councils  aa 
local  Boards  of  Health.  In  fact,  it  is  not  reasonable  to  expect 
that  members  of  village  councils,  elected  to  perform  the  various 
duties  of  the  office,  should  always  be  fully  acquainted  with  the 
latest  teachings  of  sanitary  science. 

Michigan  Report,  1874. 


Vital  Statistics. 

The  comparative  success  which  has  attended  the  eiibrts  to 
secure  these  returns  of  vital  statistics,  is  shown  by  their  steady 
increase,  while  the  per  capita  expenditure  is  not  as  great  as 
when  there  was  no  attempt  at  classification  or  study.  It  is 
only  as  to  the  returns  of  birtlis  that  our  methods  do  not  seem 
to  be  perfected.     So  far  as  vital  study  is  concerned,  we  are  able 


12 

from  those  obtained,  and  from  the  deaths  under  one  year  of 
age,  to  compute  allowauces.  But  it  woukl  be  better  if  the  re- 
turns themselves  were  more  complete.  As  it  is,  tliey  are  several 
thousand  in  advance  of  those  under  the  last  system,  beside8 
being  accompanied  with  details  of  value  in  vitnl  study.  Until 
our  governing  authorities,  an\i  especially  those  of  our  cities, 
come  to  know  that  proper  sanitary  care  and  policy  requires  that 
the  number  of  young  children  he  known,  in  order  to  limit  and 
protect  from  disease,  tliey  will  ho  insensibly  contributing  to 
the  general  death  rate. 

Wc  lind  in  the  State  no  tendency  to  resist  a  law  which  has 
its  foundations  in  a  decent  care  of  human  life.  It  is  not  of- 
ficious for  the  State,  in  the  case  of  a  marriage,  to  claim  that  it 
have  the  recorded  evidence  thereof,  with  such  appended  facta 
as,  in  the  judgment  of  those  who  have  made  the  civic  care  of 
population  a  study,  are  deemed  desirable.  As  to  births,  the 
trouble  arises  from  negligence  and  delay  rather  than  from  intent. 
Some  at  first  were  disposed  to  question  the  right  which  a  State 
has  to  enforce  a  duty  without  compensation.  This  duty  has 
been  imposed  by  a  law  on  the  statute  book  for  thirty  years,  and 
the  principle  is  acknowledged  in  many  cases,  where  lawyers, 
who  are  apt  to  protect  their  own  legal  rights,  are  required  to 
perform  services  for  which  no  direct  pay  is  provided.  It  would 
be  easy  to  show  that  incidental  benefits  accrue  to  medical  men 
from  all  laws  that  look  to  this  kiiul  of  guardianship  over  such 
vital  conditions  of  population,  as  they  Vjear  relation  to. 

As  to  deaths,  the  common  sentiment  is  that  the  death  and 
the  cause  of  death  of  every  person  should  be  authenticated. 

In  most  of  the  returns  of  death  there  is  evident  carefulness 
of  diagnosis,  or  a  note  showing  some  doubt  or  com^Jication 
which  is  recognized.  We  invite  the  attention  of  all  students 
of  statistics  to  the  data  already  on  hand,  as  showing  how  in- 
formatory  these  records  are,  if,  for  instance,  any  one  physician 
is  dispoi-ed  to  abound  in  "general  debility,''  "cancer  of  liver," 
"pyaemia  or  septicaemia"  (without  locality,)  "congestive  or 
gastric  liver"  or  other  doubtful  term,  the  return  itself  comes  to 
bo  eliminated  and  either  is  (Iroi)ped  from  the  vital  tabulation 
or  looses  its  significance  in  the  multitude  of  numbers. 

K.  M.  Hunt,  M.  D. 

Aac  Jirscy  Rrport,  l^'ol. 


13 

Until  accurate  registration  of  vital  statistics  is  thorougVily 
carried  out  by  each  State,  it  obviously  will  be  impossible  to 
have  an  efficient  system  of  State  Preventive  Medicine.  What 
we  have  said  of  the  States  may  be  applied  to  the  United  States. 
I  cite  the  following  fact  as  illustrative  of  these  remarks  :  I 
was  desirous  of  learning  whether  we  had  proof  from  reliable 
statistics  that  a  man  lives  longer  now  than  he  did  a  century 
ago.  This  is  believed  to  be  true,  i-f  we  may  judge  from  past 
history,  whcrefrom  it  seems  that  the  duration  of  life  has  been 
steadily  augmenting  with  advancing  civilization.  To  get  ac- 
curate data,  I  consulted  some  noted  experts  in  the  community, 
but  I  have  not  been  able  to  get  satisfactory  replies.  JSTot  one 
of  them  could  refer  me  to  printed  vital  statistics  ^jroyj/?^  the 
fact  for  these  United  States. 

Public  Hyrjiene  by  Henry  L.  Bowditch. 


The  Registration  of  Vital  Statistics  in  the  United  States. 

Abstract  of  a  Paper  Read  be/are  the  General  Sefsirm  of  (he  American  Social  Sciejicc 
Association,  by  Dr.  Elisha  iiams. 

The  ceilsus  enumeration  of  the  population  ought  to  be  abso- 
lutely accurate  and  complete;  but  the  method  of  enumeration 
is  so  essentially  faulty,  that,  as  respects  the  poll  of  the  living 
inhabitants,  even  the  total  columns  are  equivocal,  w^hile  all  the 
distributive  grouping  is  untrustworthy.  The  essential  vicious- 
ness  of  each  successive  census  will  remain  unremedied  until 
the  methods  of  enumeration  are  made  exact;  until  all  the  facts 
relating  to  births,  marriages  and  deaths,  and  the  causes  of  death, 
are  currently  registered  as  public  records  in  every  county  and 
State.  Vital  statistics  comprise  the  account  current  of  the 
State  with  the  lives  of  the  inhabitants.  The  registration  of 
these  statistics  is  a  duty  rendered  to  the  State,  and  is  to  be 
maintained  by  ways  and  means  which  the  State  alone  can  pro- 
vide. But  Wiiercver  a  State  has  so  provided  the  methods  and 
means  for  the  performance  of  the  duties  of  vital  registration, 
the  people  must  comply  with  alacrity  to  the  requirements  of 
the  registry  laws.  Birth  records  should  be  so  complete  as  to 
establish  and  perpetuate  the  identity  of  individuals,  and  such 
other  facts  should  be  secured  in  respect  to  both  the  child  and 


14 

its  parents  as  the  law  may  require.  Vital  ^^tatisticiau8  are  al- 
ready fully  agreed  on  the  elements  of  good  birth  records.  The 
claim,  both  of  the  State  and  the  infant,  as  to  the  record  of  its 
birth,  is  imperative,  and  allows  no  optional  delay  beyond  the 
reasonable  time  necessary  for  certifying  and  tilling  the  record 
for  public  registration.  Claiming  such  a  right,  the  State  can 
not  do  less  than  define  the  duties  and  obligations  it  imposes  on 
the  several  persons  interested,  who  can  not  justifiably  postpone 
the  certification  of  a  detailed  and  complete  record.  In  cases  of 
illnjitimatc  children^  as  much  information  as  possible  should  be  ob- 
tained, 2)arlicularly  as  to  the  occupation  and  nationality  of  each 
parent.  Such  records,  made  with  faithfulness,  will  subserve  the 
interest  of  statistical  and  biographical  science.  Faithful  regis- 
tration of  still-births  should  be  secured  by  judiciously  regulating  official 
returns  and  the  suitable  interment  of  the  remains.  The  interests  of 
morality,  as  well  as  of  science,  demand  this  record.  All  records  of 
■marriage  should  be  registered  as  soon  as  verified.  The  law  sub- 
mitted is  in  harmony  with  the  statutes  of  Massachusetts,  Con- 
necticut, Rhode  Island  and  Illinois.  Amendments  of  existinsf 
statutes  may  be  readily  etfected  in  the  States  which  need  mere- 
ly to  give  harmony  and  efficiency  to  existing  laws,  while  in 
States  which  have  only  cumbrous  and  inefficient  statutes  relat- 
ing to  marriage  registration,  the  adoption  of  an  entirely  new 
system,  under  new  laws,  will  be  more  practicable  than  amend- 
ments. The  epitomized  anthropological  history  of  a  life,  a 
faithful  certificate  concerning  time,  place  and  social  condi- 
tions of  each  death  scene,  and  medical  facts  in  regard  to 
causes  of  death  will  ever  impart  to  records  all  the  real  import- 
ance which  family.  State  and  olficers  of  health  will  justly  claim. 
All  events  and  causes  of  mortality  should  be  followed  back  un- 
til the  question  may  be  answered,  "IIow  may  human  life  hence- 
forth be  guarded  against  the  causes  of  sickness,  injury,  and 
premature  deatli?" 

As  it  is  the  chief  object  of  this  report  to  suggest  the  argu- 
ments and  i)lans  by  which  uniformity  and  completeness  should 
be  given  to  the  registration  of  vital  statistics,  we  shall  proceed 
directly  to  this  purpose  in  all  we  submit  in  regard  to  records 
and  registration.  Certain  essential  conditions  should  be  kept 
in  view  in  devising  the  plan  of  the  greatest  practical  utility 
and  completeness  in  the  records.     These  may  be  enumerated 


15 

as  a  complete  registration  of  birth  in  every  community;  com- 
plete registration  of  marriage,  the  records  of  which  shall  be 
comprehensive.  This  branch  of  registry  provides  a  basis  of 
correct  information  concerning  the  foundation  of  families. 
The  statute  should  provide  for  thorough  and  scientific  verifi- 
cation of  violent  and  unknown  causes  and  circumstances  of 
death,  and  effectual  provision  for  specially  verifying  the  fact, 
and  the  attendant  circumstances  of  deaths.  The  entire  matter 
of  records  and  registration  of  mortality  should  be  placed  under 
the  supervision  of  expert  sanitary  officers  or  boards  of  health. 


extract  from  proceedings  of  a  conference  of  yital 
Statisticians,  1880. 

Dr.  Thompson,  President  State  Board  of  Health  of  Kentuekr/y 
says:  "We  have  had  but  little  experience  in  Kentucky,  except 
in  a  few  localities,  in  gathering  these  statistics.  I  am  very 
confident  that  the  large  cities  of  the  West,  including  Cincin- 
nati, St.  Louis,  Louisville  and  Chicago,  do  not  obtain  perfect 
returns,  much  less  States  at  large.  It  is  impossible  to  give 
anything  approximating  a  correct  death  list  except  through 
physicians.  And  yet  some  physicians  think  you  are  inquiring 
into  their  private  affairs  when  you  require  that  they  shall  state 
the  causes  of  death  of  their  patients.  The  parents  and  guard- 
ians also  think  the  causes  of  death  of  friends  concern  only 
themselves.  In  Kentucky  we  are  endeavoring  to  compel  the 
physicians  to  make  the  certificate  under  oath.  It  would  take 
years  to  educate  the  public  to  make  these  returns,  but  we  can 
educate  the  physicians  much  sooner,  and  I  think  that  the  whole 
duty  must  be  put  upon  them.  It  is  true  that  it  is  for  the  bene- 
fit of  the  people,  but  it  is  also  for  the  information  of  the  profes- 
sion, and  hence,  in  my  opinion,  no  dead  body  should  be  buried 
without  the  certificate  of  the  physician.  It  is  perfectly  clear  to 
me  that  in  the  rural  districts  it  will  be  impossible  ever  to  gain 
anything  that  will  be  satisfactory,  except  through  the  pro- 
fession." 

Dr.  Lindsley,  Health  Officer,  New  Haven,  Conn.:  The  law  al- 
lowed every  town  to  elect  a  Registrar,  but  in  failure  of  such 
election  the  Town  Clerk  was  to  be  Registrar.     Wherever  he 


was  Kegistrar,  very  little  iuterest  was  taken  in  th6  matter  of 
these  certitieates,  and  frequently  he  would  make  collections  of 
them  but  once  a  year.  TJut.  where  a  l^egistrar  was  elected, 
he  took  a  personal  interest  in  it,  and  the  collections  and  records 
were  far  more  accurate  than  otherwise.  At  the  present  time 
we  have  a  law  by  which,  in  all  tlie  cities  of  the  State,  a  hi/rial 
perrnit  h  required.  That  has  been  since  the  organization  of 
the  State  Board  of  Health,  two  years  ago.  I  believe  that  it 
has  operated  so  far  very  well,  and  the  records  numerically  are 
almost  perfect.  I  know  that  it  is  so  in  New  Haven.  I  do  not 
know  of  a  single  instance  where  a  body  has  been  buried  with- 
out a  permit.  I  believe  that  the  physicians  are  the  proper  y»ar- 
ties  to  look  after  these  matter!},  and  that  we  can  educate  the 
profession  to  the  practice  of  giving  them. 

Dr.  Clerncuui:  We  have  an  undei'taker's  certificate  and  also 
a  physician's  certificate  on  the  same  blank.  I  think  in  Phila- 
delphia the  undertakers  are  registered,  and  an  inspector  is  de- 
tailed for  the  purpose  of  going  around  among  them  at  certain 
times  to  see  that  they  are  attending  to  their  duties  in  returning- 
these  certificates.  The  certificate  from  the  cemetery  is  entirely 
a  different  thing.  It  is  not  on  the  same  blank.  If  it  is  found 
that  those  certificates  do  not  coincide,  the  matter  would  be  in- 
quired into,  and  if  anything  is  wrong,  a  fine  of  $25  will  be  im- 
posed all  around.  One  has  been  enforced  within  a  month. 
The  certificate  is  returned  by  the  undertaker. 

Ijr  Thompson:  In  Kentucky,  there  are  no  registrars,  but  we 
have  City  Clerks,  and  it  is  a  finable  offence  for  the  undertakers 
to  bury  any  one  without  authority  from  the  city  to  difj  the  (jrave. 
The  City  Clerk  can  not  give  the  authority  until  he  receives  tlic 
certificate  of  the  physician.  The  family  have  to  get  that  from 
the  doctor.  It  is  generally  made  the  duty  of  the  head  of  the 
family  to  carry  that  certiiicate  to  the  physician  wherever  his 
place  of  business  is,  and  I  understand  it  works  well. 

Dr.  liauch,  Secretary  State  Board  of  Health,  of  Illinois:  There 
is  no  trouble  in  Illinois;  but  the  undertakers  are  not  the  par- 
ties who  are  made  to  make  the  returns.  The  medical  men  are 
the  parlies  responsible.  The  certificates  are,  as  a  general  rule, 
brought  to  the  office  of  registration  by  undertakers,  who  are 
puni-hable  by  fine,  as  are  cemetery  keepers  and  physicians,  for 
neglect  of  duty.     "With  regard  to  the  persons  who  should  make 


17 

these  returns,  I  would  ask  the  question  :  Ought  uot  this  re- 
sponsibilitj^  to  be  divided?  In  Illinois,  the  duty  rests  entirely 
on  the  medical  men.  Recently  the  question  of  fee  has  been 
raised.  Before  that  was  raised  there  was  no  trouble  at  all.  I 
think  it  is  the  duty  of  the  medical  men  to  make  these  returns. 
They  can  do  it  better  than  any  one  else.  It  does  not  I'cquire  a 
great  deal  of  time  and  trouble  to  obtain  what  is  required. 

Dr.  Thompson:  We  have  no -difficulty  in  Kentucky  in  get- 
ting all  tlie  information  in  regard  to  the  certificate.  The  pen- 
alty imposed  on  the  sexton  of  the  cemetery  takes  the  difficult}^ 
entirely  ofl"  our  hands.  They  are  not  allowed  to  bury  any  body 
without  a  permit  from  the  Health  Department,  and  the  Health 
Department  will  not  grant  certificates  unless  they  are  signed 
according  to  the  ordinance. 

Dr.  Ames,  of  3Iassac.huse.tts  :  The  bulk  of  the  discussion  seems 
to  be  upon  the  registration  of  cities,  as  might  naturally  be  sup- 
posed. But  there  is  a  hroad  field  in  the  country  districts.  The 
trouble  with  the  country  districts  is  that  they  arc  sparsely  settled,  and  , 
a  physician  is  called  over  a  large  territory,  and  unless  he  attends 
to  the  certificate  at  the  moment  of  death  he  may  not  be  able  to 
attend  to  it  for  some  time  afterward. 

If  there  could  be  some  one  to  vise  the  return  of  the  house- 
holder, who  makes  the  primary  return  ;  if  some  officer  of  the 
town  could  vise  it — and  I  believe  something  of  that  kind  might 
be  done — registration  laws  might  be  passed  so  as  to  secure  every- 
where completeness  of  the  return,  where  now  no  law  could  be 
passed.  And  I  commend  that  feature  of  it  to  the  attention  of 
the  committee,  as  one  which  must  everywhere  be  met,  and  ones,/ 
which  ought  to  be  met  intelligently,  and  at  the  same  time  re- 
gistration be  efi^ected. 

Dr.  White,  of  New  Orleans :  These  duties  in  New  Orleans 
are  managed  as  follows:  The  Board  of  Health  passed -iin  ordi- 
nance stating  that  no  body  shall  be  buried  in  any  part  of  the 
city,  or  removed  from  the  city,  without  a  permit  from  that 
oflice.  That  permit  is  based  on  the  certificate  of  a  physician. 
It  is  considered  the  business  of  the  family  to  furnish  the  cer- 
tificate, but  the  doctor  signs  it.  There  is  no  difficulty  of  the 
working  of  that  matter  in  New  Orleans.  No  dead  body  can 
be  removed  from  the  city  without  a  permit  from  the  Board  of 
Health,  and  a  fine  can  be  levied  on  the  railroads  for  carrying 
2— Bd.  H. 


18 

out  bodies  without  permits.     The  cliargo  for  the  burial  permit 
is,  I  think,  tifty  cents.     The  money  for  tliese  permits  goes  into 
the  treasury  of  the  Board  of  Jleaith. 
Vital  Sfofi.^tic.s,  by  J.  D.  Plavlui,  31.  D. 

Thus  far,  the  State  Board  of  Health  has  organized  and  set 
in  motion  the  system  of  registration  and  vital  statistics,  and  if 
this  system  seems  to  be  complicated,  it  is  because  numerous 
laws  relating  to  the  matter — and  all  in  operation — have  to  be 
co-ordinated  as  to  secure  the  action  of  local  authorises  as  well 
as  insure  an  efficient  supervision  and  complete  rec;ord8  at  the 
State  IJureau  of  Registry.  -i 

I)y  this  ceaseless  survey,  description,  comparison  and  map- 
ping of  the  courses  of  disease,  and  the  varying  rates  and  causes 
of  mortality  in  more  than  a  thousand  registration  districts,  the 
whole  State  will  derive  practical  results  far  more  useful  than 
any  merely  immeral  summaries  that  would  only  record  the 
total  losses  by  death,  and  the  gains  by  birth,  and  the  establish- 
ment of  families  by  marriage.  The  purpose  to  render  this 
branch  of  work  directly  tributary  to  public  interests  is  well 
formed  and  now  seems  attainable.  The  State  Board  of  Health 
has  recognized  the  practical  relations  of  this  branch  of  its 
work,  as  dciined  by  a  sanitary  statesman  of  England,  who  lias 
emphasized  his  estimation  of  it  l)y  saying  :  "  Considered  phys- 
ically, the  main  object  of  correct  civil  registration  of  births, 
deaths  and  marriages,  is  to  aid  in  disclosing  the  causes  of  dis- 
eases. Considered  legally,  the  object  is  to  provide  the  means 
of  tracing  descent  and  proving  personal  identity.  And  con- 
sidered }»olitically,  it  is  to  assist  the  government  in  arriving  at 
correct  conclusions  in  regard-to  measures  of  internal  economy, 
etc."  Completeness,  accuracy,  and  the  requisite  attestation  of 
such  records  should  be  fully  attained  under  the  system  of  vital 
statisti(^s  in  tlie  State  of  New  York. 

K.  IIakkis,  M.  B. 

New  York  Reports,  ISSO. 


19 


Work  of  Health  Boards. 

For  several  years  I  have  been  comparing  the  results  of  the 
work  of  municipal  Health  Officers,  as  contrasted  v?-ith  that  of 
municipal  Boards  of  Health,  both  in  this  country  and  Europe. 
I  find  that,  in  the  great  majority  of  cases,  the  single  officer 
succeeds  better  than  the  Board.  Where  the  Health  Officer  sys- 
tem fails  it  is  often  because  the  officer  attempts  to  continue  to 
practice  his  profession  and  perform  his  sanitary  duties.  It  is 
not  desirable  that  a  Health  Officer  should  be  a  practitioner  of 
medicine;  for,  if  he  is,  he  can  hardly  avoid  the  distrust  and 
dislike  of  his  fellow-physicians,  if  he  does  his  duty;  nor  can 
he  be  expected  to  be  as  severe  on  the  nuisances  of  his  wealthy 
and  influential  patients  as  on  those  of  others. 

J.  S.  Billings,  M.  D. 
A.  P.  H.  A.,  Vol.  VI. 


Sanitation. 

"One  of  the  first  great  objects  of  sanitary  organization,"  to 
use  the  language  of  a  distinguished  sanitarian,  "is  to  watch  the 
death  rate;  to  watch  it  not  only  over  a  city  or  parish,  but  in 
detail;  to  watch  it  from  mouth  to  month,  and  even  from  week 
to  week;  to  watch  it  as  att'ected  by  difi'erent  diseases,  and  par- 
ticularly what  are  termed  epidemic  diseases,  and  such  diseases 
as  we  believe  to  be,  in  a  great  degree,  preventable;  and  this 
done,  to  make  known  the  results  from  time  to  time  to  those 
who  are  chiefly  concerned  in  sanitary  evils,  so  as  eftectually  to 
bring  home  to  the  dwellers  in  darkness,  ignorance  and  disease, 
the  immense  significance  of  the  facts  taught  by  these  figures." 

At  the  beginning  of  the  fourth  century,  Paris  is  said  to  have 
"lost  her  population  at  the  rate  of  50  in  every  1,000  annually, 
and  notwithstanding  the  great  increase  of  her  population  up 
to  the  time  of  the  late  war,  her  death  rate  was  then  only  about 
28  in  1,000.  At  the  close  of  the  sixteenth  century,  the  aver- 
age duration  of  life  was  about  twenty-one  years;  in  1833  it  was 
forty-five  years  and  five  mouths." 

Under  the  influence  of  improved  sanitary  measures,  wher- 


20 

ever  they  have  ]>eeii  strictly  enforced  and  intelligently  con- 
ducted, the  ref<ults,  though  lar  from  what  it  is  yet  hoped  to  at- 
tain, arc  even  more  gratifying.  In  England,  after  the  adoption 
of  measures  for  the  improvement  of  cities,  "in  nineteen  towns 
the  annual  mortality,  which  had  heon  28  in  1,000  for  years  pre- 
vious to  the  improvement,  fell  to  21  in  1,000." 

In  Liverpool,  the  rate  of  mortality  was  reduced  from  38.4  in 
1,000  to  20  in  1,000.  In  five  towns,  according  to  Latham  on 
Sanitary  Engineering,  "  the  saving  of  life  =i=  *  *  averaged 
25  per  cent.;  while  in  the  two  diseases,  typhoid  fever  and  con- 
sumption, tlie  average  reduction  was  55  and  25  per  cent.,  re- 
spectively." 

It  is  further  sliown  b}'  Dr.  Gqo.  Buchanan  that,  by  the  intro- 
duction of  sewerage,  drainage,  and  water  supply  into  twenty- 
five  cities  and  towns,  possessing  an  aggregate  population  of 
593,736,  "the  average  of  the  death  rate  per  10,000  for  the 
ditiferent  places,  liad  decreased  as  follows:  From  all  causes 
from  247.55  to  219.87;  from  typhoid  fever,  from  13.34  to  7.8; 
from  diarrhea,  from  8.45  to  7.66 ;  from  pulmonary  consump- 
tion, from  33.44  to  27.3;  among  infants  under  one  year,  from 
55.65  to  50." 

One  additional  example,  drawn  from  the  sanitary  records  of 
England,  where  hygienic  measures  for  the  prevention  of  dis- 
ease have  been  longest  and  most  elficiently  pursued,  may  be  de- 
duced from  the  testimony  of  Dr.  Buchanan  in  the  ninth  report 
to  the  Privy  Council,  showing  that  in  twenty-five  towns  where 
a  system  of  sewerage  liad  been  introduced,  in  nine  of  these 
the  number  of  deaths  was  diminished  over  50  per  cent.,  and 
in  ten  others  from  33  to  50  per  cent.,  the  average  reduction  be- 
ing about  45  per  cent. 

Even  in  the  United  States,  wliere  sanitary  supervision  has 
been  only  partly  and  recently  introduced,  during  the  last  twenty 
years,  up  to  and  including  1870,  the  percentage  of  deaths  to  the 
population  had  decreased  from  1.39  in  l,p00  to  1.28  in  1,000. 
According  to  Dr.  Henry  B.  Baker,  the  efficient  Superintendent 
of  Vital  Statistics  of  Michigan,  the  death  rate  in  that  State  had 
been  decreased  at  each  census.  In  1850  it  was  1.14;  in  1860, 
.99;  in  1876,  .94  i»er  cent.,  effecting  a  saving,  in  a  single  year, 
of  2,317  lives,  and,  if  we  regard  its  financial  aspect,  a  total  of 
^1,899,940. 


21 

St.  Louis,  from  one  of  the  most  unhealthy,  has  been  raised 
to  one  of  the  healthiest  cities  of  the  United  States;  and  such 
has  been  the  gratifying  result  of  the  general  attention  paid  to 
the  improvement  of  cities,  and  the  removal  or  destruction  ot 
the  recognized  causes  of  disease,  that  it  has  been  laid  down  as 
a  rule,  that  any  excess  over  14  deaths  in  1,000  of  population, 
is  unnecessary,  and  the  result  of  known  hygienic  laws.  That 
such  result  can  be  attained  is  a  legitimate  conclusion  from  what 
has  already  been  achieved,  as  in  St.  Louis,  just  mentioned, 
where  the  death  rate  for  1875  was  only  14.46  per  1,000. 

Another  fact  encouraging  to  those  engaged  in  the  work  of 
sanitary  reform  is  that  so  forcibly  alluded  to  by  Dorman  B. 
Eaton,  LL.  D.,  in  a  discourse  delivered  in  1875,  that  as  the 
health  of  communities  increases,  crime  diminishes.  In  Glas- 
gow, while  the  death  rate  fell,  between  1869  and  1873,  from  34 
in  1,000  to  29.09  per  1,000,  the  whole  number  of  crimes  were 
reduced  from  10,899  to  7,876;  1867  to  1873,  of  thefts  alone 
there  was  a  reduction  of  from  1,192  to  264.  . 

These  facts  are  rapidly  forcing  themselves  upon  the  observa- 
tion of  the  public.  The}'  have  attracted  the  attention  of  Legis- 
latures and  State  authorities  everywhere,  and  their  legitimate 
result  has  been  the  creation  of  State  Boards  of  Health  in  nearly 
one-third  of  the  States  of  the  Union. 

F.  M.  Hatch,  M.  D.,  Sec'y. 

Report  of  State  Board  of  Health  of  California,  1877. 


Vaccination. 

As  a  rule,  one  successful  vaccination  in  childhood  protects 
until  about  fourteen  or  sixteen  years  of  age.  If,  however,  there 
be  epidemics  of  small-pox  near,  or  the  danger  of  exposure  great, 
the  process  may  be  repeated  oftener,  as  there  can  no  harm  re- 
sult, as  no  effect  will  be  produced  if  the  person  be  already  pro- 
tected by  the  previous  operation.  One  trial,  however,  in  face 
of  danger,  is  not  conclusive,  and  care  should  be  taken  that  the 
operation  be  thoroughly  performed. 

In  England,  the  small-pox  death  rate  has  decreased  one-half 
since  the  introduction  of   compulsory  vaccination.     In  many 


22 

cities  wlierc  periodical  inspection  of  all  the  schools,  and  house 
to  house  visitation,  with  free,  though  not  compulsory,  vaccina- 
tion takes  place,  often  the  disease  is  hardly  known  unless  im- 
ported, and  then  nevt-r  becomes  extensively  prevalent,  but  is  at 
once  stamped  out. 

The  number  of  persons  efficiently  vaccinated  or  successfully 
revaccinated,  that  are  attacked  even  during  an  epidemic,  is  very 
small;  and  where  the  vaccination  has  been  imperfect  the  dis- 
ease is  usually  greatly  modified  in  severity. 

When  successful  vaccination  and  revaccination  has  been  done, 
the  i)roportion  of  deaths  to  attacks  is  but  one-seventieth  part 
of  that  in  unvaccinated  persons.  By  universal  revaccination, 
sniali-pox  has  been  stamped  out  of  the  army  and  navy.  Ex- 
p,erience  here  shows  that  one  successful  revaccination  in  an 
adult  is  sufficient.     (England). 

ConnccHcuf  Beport,  1879. 


How  TO  l^KDrcE  THK   Deatu  Kate. 

There  are  reported  in  the  vital  statistics  for  1871,  75  deatha 
as  having  occurred  from  small-pox;  or,  when  "corrected"  by 
multiplying  by  1.86,  130  deaths. 

Compulsory  vaccination,  carefully  carried  out  by  faithful  and 
vigilant  local  Boards  of  Health  in  every  city,  village,  and 
township  of  the  State,  together  with  more  complete  isolation 
of  every  case  of  variola  and  varioloid,  under  t'ne  present  sta- 
tutes of  the  State  on  this  subject,  would,  without  doubt,  reduce 
the  mortality  from  this  cause  to  a  very  small  per  cent,  of  what 
it  now  is. 

Can  any  one  doul)t  that  the  same  may  be  true  in  respect  to 
tfie  (596  (or,  as  corrected,  1,294)  cases  of  deatli  from  scaHatina? 

It  seems  a  late  day  to  point  out  the  danger  of  its  contagion, 
and  the  absolute  necessity  of  complete  isolation  for  the  [)reven- 
tion  of  the  spread  of  this  disease  so  fearfully  latal  among  chil- 
dren. There  has  grown  up  a  feeling  in  the  public  mind  as 
productive  of  evil  as  it  is  devoid  of  truth,  that  scarlatina  is  one  of 
the  inevitable  children's  diseases,  and,  although  often  extreme- 
ly dangerous  to  life,  it  must  be  submitted  to,  and,  on  the  whole^ 
the  sooner  the  children  have  the  disease  the  better. 


23 

If  the  same  care  of  isolation,  too,  were  used  in  cases  of 
measles,  diphtheria  and  whooping  cough,  the  fatality  from 
these  diseases  would  be  largely  reduced.  And  what  is  true  of 
these  last  named  diseases  is,  for  far  stronger  reasons,  true  of 
typhus  and  typhoid  fevers.  Let  all  public  and  private  nuis- 
ances be  abated,  and  all  private  and  public  rooms  be  well  ven- 
tilated, and  we  shall  have  recorded  but  very  few  original  cases 
of  typhus  or  typhoid  fevers;  and  let  these  few  be  strictly  and 
comi)letely  isolated,  and  no  other  would  follow. 

H.  O.  Hitchcock,  M.  D. 

Michigan  Hepori,  1876. 


I. — Small-pox  a  Prevkntable  Dlseask, 

It  has  long  been  known  that  small-pox  can  be  prevented  or 
modified  by  vaccination.  It  is  now^  believed  that  a  wide-spread 
epidemic  of  the  disease  can  be  attributed  only  to  an  equally 
wide-spread  ignorance  or  willfulness  concerning  small-pox  and 
its  prevention  by  vaccination.  No  intelligent  person  need  have 
small-pox. 

II, — Why  Vaccinate? 

Because  unmodified  small-pox  is  so  deadly  a  (iisease,  and  so 
often  disfigures  and  enfeebles  those  who  recover,  and  because 
by  traveling  or  by  travelers,  by  articles  received  in  the  mail  or 
from  stores  or  shops,  or  in  various  other  ways,  any  one  at  any 
time  may,  without  knowing  it,  be  exposed  to  small-pox,  it  be- 
comes important,  so  far  as  possible  without  injury  to  health,  to 
render  every  person  incapable  of  taking  the  disease.  This  may 
be  done  so  perfectly  by  vaccination  and  revaccination  with 
genuine  bovine  vaccine  virus,  that  no  question  of  ordinary  ex- 
pense or  trouble  should  be  allowed  for  a  day  to  prevent  the 
careful  vaccination  of  every  man,  woman,  and  child  in  Michi- 
gan, and  the  revaccination  of  every  one  who  has  not  been  vac- 
cinated within  five  years.  It  is  well  established  that  those  who 
have  been  properly  vaccinated  are  far  less  likely  to  take  small- 
pox if  exposed  to  it,  and  that  the  very  few  who  have  been  pro- 


24 

pcrly  viifc'liiated,  and  have  siiiall-pox,  liavo  it  in  a  much  milder 
form  and  are  much  less  distigured  hy  it  than  tho.se  who  have 
not  been  thus  vaccinated. 

In  Sweden  the  average  numl)er  of  deaths  in  each  year 'from 
small-pox  per  one  million  inhabitants  was: 

Before  the  introduction  of  vaccination  (1774-1801) 1,973 

During  the  period  of  optional  vaccination  (1802-181G) 479 

During  the  period  of  obligatory  vaccination  (1817-1877)....    189 

Vaccination  was  introduced  in  England  near  the  beginning 
of  the  present  century,  and  since  1853  compulsory  vaccination 
has  been  attempted.  In  England  the  number  of  deaths  in  each 
year  from  small-pox  per  one  million  inha])itants  was: 

At  the  close  of  the  last  century. ...<. 3,000 

'  From  1841  to  1853  (average) 304 

From  1854  to  1863  (average) 171 

In  the  Bavarian  army  revacci nation  has  been  compulsory 
since  1843.  From  that  date  till  1857  not  even  a  single  case  of 
unmodified  small-pox  occurred,  nor  a  single  death  fi\)m  small- 
pox. 

During  forty-two  yeai's  of  duty,  Dr.  Marson,  physician  of 
tlie  London  Small-pox  Hospital,  has  never  observed  a  single 
case  ot  small-pox  in  the  officers  and  employe;?  of  the  hospital, 
who  are  revaccinated  when  they  enter  the  service,  and  who 
are  constantly  exposed  to  the  infection. 

"Out  of  more  than  10,000  children  vaccinated  at  Brussels 
with  animal  lymph,  from  1865  to  1870,  and  who  went  through 
the  terrible  epidemic  of  small-pox  which,  in  1870  and  1871, 
frightened  the  world,  not  a  single  one  was,  to  my  knowledge, 
reported  as  being  attacked  by  the  disease.  The  same  inmiu- 
nity  was  shared  by  those,  a  much  larger  number,  whom  I  had 
revaccinated,  and  who,  at  the  same  time,  were  living  in  epi- 
demic centers." — Dr.  Warlemont,  of  Brussels,  in  North  Carolina 
Medical  Jonrnal,  January,  1880,  Vol.  V.,  p.  2. 

III. — Who  Should  be  Vaccix.\ted. 

Every])()dy,  old  and  young,  for  his  own  interest,  and  that  he 
may  not  become  a  breeding  place  for  the  distribution  of  small- 
pox to  others,  should  seek  that  protection  from  small-pox 
which  is  altbrded  by  vaccination  alone. 


'lb 
IV. — Who  Should  not  be  Vaccinated. 

Unless  exposure  to  small-pox  is  believed  to  have  taken  place, 
or  likely  to  take  place,  teething  children,  pregnant  women, 
persons  suflering  with  measles,  scarlet  fever,  erysipelas,  or 
susceptible  to  and  recently  exposed  to  one  of  these  diseases, 
persons  suffering  with  skin  disease  or  eruption,  and  in  general, 
feeble  persons  not  in  good  healtl^,  should  not  be  vaccinated. 
In  all  cases  in  which  there  is  any  doubt  as  to  the  propriety  of 
vaccinating  or  postponing  vaccination,  the  judgment  of  a  good 
physician  should  be  taken.  The  restriction  as  to  vaccinating 
teething  children,  makes  it  important  that  children  should  be  * 
vaccinated  before  the  teething  process  has  begun,  because  small- 
pox is  very  much  more  dangerous  than  vaccination.  Small-jiox 
is  exceedingly  dangerous  to  pregnant  women. 

Reasons  for  preferring  bovine  virus  to  humanized  virus  may 
be  given  as  follows :  (1)  By  the  use  of  the  bovine  virus  there 
is  secured  a  more  perfect  or  typical  development  of  the  vaccine 
disease;  and  hence,  it  may  fairly  be  inferred,  a  greater  protec- 
tion against  small-pox.  (2)  With  the  bovine  virus  an*d  with  a 
clean  lancet,  and  with  clean  surroundings,  there  is  no  danger 
of  communicating  syphilis.  (3)  The  bovine  virus  is  far  more 
effective  than  the  humanized  virus  in  re  vaccination;  and  where 
the  humanized  virus  fails,  and  the  bovine  virus  works,  it  is 
probable  that  there  was  susceptibility  to  small-pox  which  the 
humanized  virus  did  not  remove,  but  which  has  been  removed 
by  the  bovine  virus.  (4)  Greater  care  can  be  taken  in  the  prop- 
agation of  bovine  virus,  a  greater  supply  can  be  always  at 
command,  and  always,  but  especially  in  time  of  urgent  danger 
from  small-pox,  people  can  have  a  better  guarantee  that  they 
are  vaccinated  with  genuine  and  pure  vaccine  virus. 

Michigan  Report,  1881. 


Conditions  of  Good  Sanitary  Administration. 

But  the  arguments  that  sickness  and  death,  as  they  occur,  are 
providentially  inevitable,  and  that  pestilence  and  famine  are 
pre-ordained  messengers  of  God's  wisdom  and  wrath,  before 
which  we  must  dismiss  our  reason — that  our  precautions  against 


26 

them  lire  viiin  iioutings  of  oiir  wisdom  in  tlie  face  of  Divine 
Providence — sire  so  nearly  monopolized  by  illiterate  grandma- 
mas  and  snju'rannuated  bigots,  as  to  be  elements  of  precantion 
hardly  wortliy  of  notice  in  our  sanitary  condition  on  earth. 
Tiiongh  Dr.  Lyon  IMayfair,  now  a  professor  at  Edinburgh, 
says  that  in  his  day  Scotcli  professors  dared  not  preach  such 
heretical  doctrines,  and  it  is  not  very  long  since  an  English 
comjjany  was  refused  the  lil>erty  of  deepening  the  channel  of 
the  (Juadaiquiver,  because,  it  was  argued,  that  if  God  had  in- 
tended the  river  to  be  navigated.  He  would  bave  made  it  navi- 
giildc. 

It  is,  I  think,  safe  to  say  that  London  and  Paris  lost  more 
lives  needlessly,  both  by  the  plague  and  by  the  cholera,  in  ten 
weeks,  than  either  of  them  have  so  lost  during  the  last  twenty 
years.  Bordeaux,  then  one  of  the  filthiest  towns  in  Europe, 
lost  18,000  out  of  40,00  of  its  people  in  a  few  weeks.  The 
plague  remained  longest  in  Naples,  which  was  perhaps  the 
worst  ventilated  and  worst  drained  of  the  large  cities  of  Eu- 
rope. 

There  is  nothing  better  settled  in  regard  to  life  and  health 
than  that  such  diseases  as  cholera,  yellow  fever,  small-pox,  ty- 
phus and  typhoid  fever,  can  be  in  great  measure  kept  away  by 
good  sanitary  administration,  the  cost  and  loss  of  which  is  in- 
finitesimal compared  with  what  these  diseases  would  cause. 
They  have  been,  by  such  means,  so  far  kept  out  of  New  York, 
that  for  ten  years  they  have  caused  less  aggregate  loss  and  cost, 
I  presume,  than  either  the  toothache  or  the  mumps.  Cholera 
came  live  times  to  English  ports  in  1873,  and  twenty-eight  died 
of  it  on  one  foreign  ship  in  London,  and  yet  such  were  the  pre- 
cautions that  not  a  single  Englishman  took  the  disease.  In 
the  city  of  Bombay,  with  its  population  of  650,000,  made  up 
of  all  the  races  of  Europe  and  Asia,  and  situated  in  a  region 
where  plagues  and  leprosies  and  choleras,  have  through  all  his- 
toric time  reaped  their  greatest  harvests  of  death;  where,  in 
1820,  150,000  persons  died  from  one  of  these  scourges  in  a  few 
weeks,  and  the  average  death-rate  had  always  been  alarmingly 
high;  in  such  a  city,  within  a  few  years,  good  sanitary  admin- 
istration, introduced  from  England,  has,  by  enforcing  drainage, 
ventilation,  adecpiate  air-space,  by  having  good  w^ater  and 
wholesome  food  and  general  cleanliness,  accomplished  result-s 


*  27 

which  are  marvelous.  The  death-rate  of  Bombay,  in  1873 — 
only  about  an  average  year — was  only  slightly  over  24  to  a 
thousand  of  its  people;  and  Dr.  Harris  says  its  death-rate  in 
1874,  was  23.9  to  the  thousand,  being  a  lower  rate  than  that  of 
Vienna,  or  Berlin,  or  I^ew  York,  or  Baltimore,  or  Richmond. 
Analogous  results  have  been  secured  in  Calcutta  and  Ilong 
Kong. 

_  Professor  Lyon  Playfair  says  the  death-rate  of  London  from 
1660  to  1679,  was  not  less  than  80  out  of  every  thousand  each 
year.     About  the  latter  date  better  sanitary  precaution  began 
to  be  applied  in  that  city,  and  especially  since  1848,  they  have 
been  largely  and  continually  improved.     Much  the  same  has 
been  ilia  sanitary  history  of  Paris.     The  wonderful  results  are 
that  these  two  largest  are  among  the  healthiest,  and  the  very 
cleanest  of  the  great  cities  of  the  world.      If  N'ew  York,  or 
.  Philadelphia,  or  Chicago,  or  St.  Louis*  or  Cincinnati,  or  Balti- 
more, was  as  cleanly  and  well  paved  as  either  Paris  or  London, 
the  ratio  of  crime,  poverty,  death,  and  taxes,  would  go  down, 
their  pride,  population,  and  productive  industry,  would  go  np, 
and   reupblican   institutions    would   be  crowned    with  a  new 
honor.      The  average  death-rate  of  London   for  the  past  ten 
years  has  been  only  24  to  the  thousand   annually.     In  1874, 
with  its  3,400,700  people,  the  death-rate  was  only  22.04  to  the 
thousand.     The  average  death-rate  of  all  England,  for  the  ten 
years  last  past,  has  been  22.04  to  her  thousand,  which  is  prob- 
ably lower  than  in  this  country;  so  that  good  sanitary  admin- 
istration has  brought  down  the  death-rate  of  the  two  largest 
cities  in  the  world,  and  the  largest  city  of  India,  nearly  to  that 
of  the  general  death-rate  of  two  of  the  most  healthy  countries 
of  the  globe  peopled  by  the  most  vigorous  and  enlightened 
of  the  race  of  men. 

Taking  the  records  of  1873,  and  rejecting  fractious,  the 
death-rates  per  thousand  of  population  per  year  in  some  of  the 
principal  European  and  American  cities  w^ere  as  follows:  Lon- 
don, 22,  and  New  York,  29;  Liverpool,  25,  and  Philadelphia^ 
19  ;  Glasgow,  28,  and  Richmond,  33;  Edinburgh,  21,  and  Balti- 
more, 24;  Berlin,  27,  and  Cincinnati,  22;  Birmingham,  25,  and 
Savannah,  43;  Dresden,  34,  and  New  Orleans,  37;  Munich,  45, 
and  Valparaiso  (a  very  unclean  city),  64.  It  will  be  observed 
that  the  average  death-rate  in  American  cities  is  higher  than 


28  * 

111  England,  tliougli,  perhaps,  not  higher  than  in  German  cities, 
where  public  health  in  cities  has,  until  very  recently,  been  neg- 
lected. 

Our  city  death-rate  among  children  under  one  year  of  age 
is  much  higher  than  in  English  cities. 

The  high  relative  death-rates  of  Munich  and  Dresden,  have 
caused  measures  to  be  taken  on  a  large  scale  for  improving 
their  drainage,  water  supply,  and  ventilation;  and  v^ery  soon 
weniay  be  sure  the  rate  will  go  down.  The  comparative  low 
rate  of  Liverpool  has  been  secured  by  the  most  vigorous 
administration,  which  within  a  few  years  has  produced  results 
which  every  observing  traveler  has  noticed. 

Interesting  results  of  sanitary  administration  in  smaller 
cities  and  villages  might  be  drawn  indefinitely  from  Eng- 
lish experience,  and  it  is  in  that  country  that  such  administra- 
tion has  been  carried  f(5rward  with  the  most  thoroughness.  I. 
give  these  examples  from  the  report  ot  the  medical  officer  to 
J'arliament,  made  in  1867,  relating  to  villages  of  from' 5,000  to 
2,000  inhabitants.  It  comprises  the  health  statistics  for  ten 
^'cars  before  the  sanitary  reform,  with  tliose  of  the  ten  years  fol- 
lowing them. 

In  Cardiff,  wliere  typhoid  fever  and  diarrhoeal  diseases  had 
prevailed,  the  former  subsided  in  the  ratio  of  17  to  10,  and 
the  latter  in  that  of  17  to  4;  while  the  aggregate  death-rate  ot 
the  place  fell  35  per  cent.  In  Salisbury  the  death-rate  fell  20 
per  cent,  and  typhoid  ferver  and  diarrhoea  subsided  in  the  rates 
of  14  to  4.  Consumption  subsided  in  Salisbury,  40  per  cent.; 
in  Ely,  47  percent.;  in  Rugby,  43  per  cent.;  in  Bouberg,  41 
per  cent. ;  in  Worthing,  36  per  cent. ;  in  Newcastle,  32  per  cent. 

If  anybody  consoles  himself  with  the  thought  that  we  need 
no  such  work  in  this  country,  let  him  read  the  first  report  (made 
in  1873)  of  the  State  Board  of  Health  of  Minnesota — that  fresh 
young  paradise  of  health  to  which  so  many  go  to  be  cured.  In 
that  report  we  are  told  that,  in  1871,  forty  per  cent,  of  all 
<leaths  in  the  State  occurred  among  children  not  over  one  year 
of  age;  that  more  deaths  are  attril)uted  to  typhoid  fever  than 
to  any  other  disease;  that  3,000  persons  are  (constantly,  as  I 
understand)  sick  of  that  long-lingering,  exhausting  complaint; 
that  the  average  age  of  those  thus  carried  away  is  twenty-five 
years;  that  there  is  the   least  of  such  sickness  in  two  larger 


29 

cities  wlicre  there  is  most  cleanliness;  ami  the  chief  cause, of 
this  disease  th^  report  declares  to  be  "filth  Avhich  accumulatfes 
about  us,  contaminating  the  air  we  breathe  and  tlie  water  we 
drink;  that  there  is  in  most  of  the  large  towns  a  criminal  want 
of  attention  to  the  construction  of  sewers  and  the  removal  of 
the  contents  of  privies.'"'  Xow,  Minnesota  is  not,  relatively, 
an  unhealthy  State,  nor  conspicuously  in  such  sad  sanitary  con- 
dition. But  what  shall  we  say  of  a  people,  with  such  a  record, 
^which  refuses  to  vote  more  than  $250  per  year  to  its  Board  of 
Health;  or  of  Virginia,  refusing  to  vote  a  dollar  for  its  State 
Board  of  Health,  while  seeking  immigrants  from  England  in 
presence  of  a  death-rate  in  Richmond  a  third  higher  than  that 
of  London  in  1873,  and  higher  than  that  of  Bombay  in  1874 ! 
And  such  facts  as  to  the  death-rate  of  young  children  under  one 
year  of  age  lose  none  of  their  painful  interest  when  we  read  in 
the  English  medical  report  of  1873,  that  in  about  one-Seventh 
part  of  England  the  death-rate  among  children  is  only  from 
eight  to  twelve  per  cent,  of  the  entire  deaths,  and  that  in  no 
district  is  that  ratio  higher  than  thirty  per  cent. ;  that  is  less  than 
one- half  that  of  Minnesota. 

As  we  leave  this  part  of  the  subject,  let  us  remember  that  a 
small  reduction  of  a  death-rate  means  a  large  reduction  of  dis- 
abling sickness — exemption  from  pain  and  anxiety  in  cases 
innumerable,  and  the  value  of  which  no  money  can  measure — 
and  an  improved  physical  tone  and  capacity  for  study,  work  and 
happiness  equally  incommensurable. 

Dr.  Blayfair  says,  if  England  could  be  relieved  of  125,000 
needless  deaths,  ann'ually,  she  would  also  be  relieved  of  4,200,000 
cases  of  sickness;  but  he  does  not  tell  us  of  how  many  hun- 
dreds of  millions  of  indigestions  and  headaches.  Many  strik- 
ing illustrations  of  the  truths  herein  set  forth  might  be  drawn 
from  the  sanitary  administration  of  this  country,  but  the  limits 
of  this  paper  forbid,  and  my  selections  might  awaken  jealousy. 
The  beniiicent  results  attained  in  the  city  of  New  York,  how- 
ever, are  conspicuous.  Beginning  in  1866,  when  political  doc- 
tors and  ignorant  and  mercenary  partisans  were  the  health 
officers,  the  good  work  of  sanitary  reform,  then  placed  and  since 
continued  in  the  hands  of  men  of  benevolence,  science  and 
wisdom,  has  produced  fruits  in  the  presence  of  which  a  great 
metropolis  and  a  whole  nation  may  well  be  proud  and  take- 


30 

courage.  Contagions  and  epidemics  have  been  disarmed  and 
averted;  noxious  occupations  and  deadly  nuisances  without 
numi)er,  besides  more  than  two  liundred  slaughter-houses,  have 
been  removed.  Cellars,  garrets  and  tenement  houses,  more  fatal 
than  a  decree  of  Herod  to  infantile  life,  have,  on  a  vast  scale, 
been  cleansed  and  ventilated;  and  the  rate  of  mortality,  the 
security  and  the  general  comforts,  especially  of  humble  life, 
have  been  increased;  the  best  registry  of  vital  statistics  in  this 
country  has  been  established,  and  last,  but  not  least,  an  appre- ^ 
ciative  and  inspiring  public  sentiment,  which  welcomes  good 
sanitary  administration  as  a  public  blessing,  and  has  extended 
over  the  Union,  has  been  there  developed. 

Dorman'B.  Eaton,  LL.  D. 
A.  P.  H.  ^l.s.v.  Reports,  Vol.  11. 


Homes  fok  the  People. 

In  the  year  1857,  the  annual  death-rate  for  the  rural  districts 
of  England  and  Wales  was  17  per  1,000  of  the  population,  the 
aggregate  9,750,000  people  distributed  over  350,000,000  acres, 
giving  nearly  36  acres  to  each  person;  during  the  same  year 
the  i^ortality  in  towns  and  cities  among  a  population  aggregat- 
ing 8,250,000,  located  on  lands  amounting  in  all  to  2,150,00  J 
acres,  or  rather  less  than  4  persons  to  one  acre,  was  25  per  1,000, 
or,  on  the  total  number  from  overcrowding,  alone,  an  aggre- 
gate of  <j8,000  preventable  deaths  per  annum.  The  same  law 
of  an  increasing  death-rate,  resultant  from  overcrowding  was 
illustrated  during  the  cholera  year,  1854,  in  the  same  countries. 
There  were  134  districts  in  which  the  population  averaged  915 
persons  to  the  square  mile;  404  districts  in  which  the  density 
of  the  populatii)n  was  only  225  to  the  square  mile,  and  85  dis- 
tricts in  which  there  were  only  122  persons  to  the  square  mile. 
The  death-rate  from  cholera  was  nil  in  the  85  districts  sparsely 
peopled,  7  in  the  10,000  where  the  population  was  22.5  to  the 
square  mile,  and  more  than  nine  times  that  number,  or  65  in 
10,000,  in  the  more  densely  peopled  districts.  The  bearing  of 
such  figures  can  hardly  be  questioned. 

We  do  not,  from  these  startling  results,  arrive  at  the  conclu- 
sion that  city  life  is  per  se  destructive  to  vitality.     There  are 


31 

already  abundant  statistics  to  render  any  such  idea  impossible 
for  the  well-informed  mind,  and  whenever  the  tables  of  mor- 
talities for  cities  shall  be  compiled  oi>  ph)ns  adapted  to  show 
the  health  and  life  rates  obtaining  in  different  localities  more 
and  less  favored  by  position,  by  construction,  and  ventilation  of 
buildings,  by  area  of  breathing  room,  by  efficient  sewerage 
and  by  meteorological  conditions,  we  shall  find  a  much  more 
effective  reply  to  such  a  conclusion. 

•  Some  of  the  best  results  recorded  as  to  vitality  are  found  in 
towns,  and  may  be  illustrated  by  a  few  figures  submitted  to 
the  Social  Science  Association  by  Mr.  Michael,  the  Mayor  of 
Swansea,  Wales.  That  gentleman  caused  the  vital  statistics 
of  Swansea  to  be  divided  according  to  the  respective  densities 
of  population,  and  he  found  the  A  division,  resident  in  super- 
ior houses  apart  from  each  other  or  standing  on  their  own 
grounds,  subject  to  a  mortality  of  only  11  in  the  1,000  per  an- 
num, while  the  C  division  suffered  a  mortality  of  36,  or  nearly 
3 J  times  the  minimum,  and  the  intermediate  density  lost  20  in 
the  1 ,000,  or  9  more  than  the  A  division. 

It  is  claimed  by  some  writers  that  the  human  race  would  be 
extinguished  in  less  than  two  centuries  if  confined  to  large 
cities;  but,  manifestly,  that  would  depend  upon  the  conditions 
by  which  they  were  surrounded,  as  the  Swansea  A  division 
compares  favorably  with  suburban  vitality,  and  there  is  no 
reason  known  among  men  why  every  man,  woman  and  child 
should  not  have  a  never-failing  supply  of  pure  air. 

London  shows  an  aggregate  of  10,000  deaths  per  annum  in 
excess  of  births,  but  there  are  parts  of  London  that  are  as  fa- 
vorable to  longevity  as  those  occupied  by  the  A.  division  at 
Swansea;  and  in  the  worst  cities,  hygienically  considered, 
length  of  life  is  found  dependent  upon  individual  action  in  a 
very  great  degree.  For  very  many  centuries  the  Jews  were 
systematically  persecuted  by  governments,  and  people  all  over 
Europe,  condemned  to  live  in  particular  quarters  in  all  the 
principal-  cities,  and  robbed  without  scruple  by  the  ruling  class, 
if  they  were  so  ill-advised  as  to  make  a  show  of  comfort  or 
wealth.  Under  such,  and  manifold  other  disadvantages,  they 
adhered  more  or  less  strictly  to  the  rules  of  life  with  reference 
to  personal  purification  laid  down  for  them  of  old  time,  and  we 
find  them  leading  the  whole  human  race  to-day  in  the  essen- 


82 

tiuls  ol"  vitality.  I'rus.siiui  stuti.stics  show  that  the  mortality  per 
year  among  100,000  Jews  is  less  hy  800  tlian  the  deaths  in  the 
same  time  among  the  same  nnmher  of  Christians  ;  the  numhers 
being  2,161  Jews  to  2,961  Christians;  and  in  dvery  particular 
the  chosen  people  manifest  greater  powers  of  endurance.  A 
few  results  obtained  from  100,000  on  each  side,  will  show  how 
complete  amd  advantageous  is  the  contrast  ^ivoring  the  Jews. 
There  were  among  the  Christians  143  still-births;  among  the 
Jews,  89;  a  difference  of  54  to  our  disadvantage.  It  might  be* 
supposed  that  the  decreased  number  of  still-births  would  be  off- 
set by  a  larger  average  of  weakness  in  the  offspring  of  Israel, 
but  preciselv  the  reverse  is  the  fact,  as  only  453  children  of  that 
race  die  under  one  year,  while  697,  or  more  than  50  per  cent, 
above  tlie  Jewish  average,  die  in  the  lirst  year  out  of  the  aggre- 
gate of  Christian  births.  In  the  four  years  next  ensuing,  386 
Jewisli  children  die,  the  offspring  of  Christians,  already  much 
smaller  in  number,  still  heading  the  death-rate  by  nearly  25  per 
cent.,  the  number  being  477.  From  five  years  old  to  fourteen, 
151  children  of  the  Jewish  children  fall  out  of  the  ranks,  and 
one-third  more,  or  202  Christian  children  die.  From  that  age 
until  twenty-five,  the  Jews  lose  125,  the  Christians  155. 

During  the  twenty  years  ending  at  forty-five,  there  is  a  loss 
among  the  Jews  of  231,  and  among  the  Christians  of  334,  or 
103  in  excess.  So  marked  was  the  exemption  of  the  Jews  from 
the  plagues  that  decimated  all  nations  during  the  middle  ages, 
that  they  were  charged  with  having  poisoned  wells  and  springs, 
and  only  active  interference  on  the  part  of  the  authorities  pre- 
vented a  general  massacre  of  the  cleanliest  people  on  the  con- 
tinent. 

These  illustrations  show  the  potency  of  their  modes  of  lire  in 
warding  oft'  maladies,  as  well  as  sustain  the  proposition  that 
men  ma}'  make  city  life  conduce  to  comfort  and  longevity  by 
wisely  controlling  circumstances.  Men  need  not  fall  victims  to 
epidemics,  although  surrounded  b}"  evil  conditions,  unless  they 
allow  their  physical  systems  to  become  weakened  and  their 
minds  to  sink  into  demoralization. 

Town  life  is  not  necessarily  more  brief  nor  less  healthful  than 
life  in  the  country.  The  conditions  of  longevity  can  be  filled 
in  one  location  as  well  as  the  other. 

Wisconsin  Report. 


1 


33 

The  first  annual  report  of  the  Indiana  State  Board  of 
Health  will  shortly  be  issued.  The  statistical  portion  of  that 
report  will  embrace  returns  of  births,  marriages,  deaths,  and 
diseases  dangerous  to  public  health,  as  received  from  Health 
Officers  up  to  September  80, 1882.  We  give  here  the  following 
extract  from  the  forthcoming  report: 


There  is  an  opinion  held  by  many  that,  while  sanitary  rules 
are  needed  to  be  enforced  in  cities,  and  for  this  purpose  City 
Boards  of  Health  are  needed,  or  are  at  least  allowable,  in  the 
country  there  is  no  necessity  for  any  such  rules  or  organizations. 
In  the  country  it  is  held  that  the  air  is  pure,  and  the  water 
uncontaminated,  that  the  ill  effects  of  over-crowding  are  not 
known,  and  that  preventable  sickness  is  comparatively  un- 
known outside  of  the  crowded  cities. 

If  we  attempt  to  reason  with  those  holding  such  views,  we 
are  met  with  a  general  denial,  and  the  advancement  of  certain 
ideas  derived  from  the  poetical  view  of  the  case,  the  "tangled 
wildwood,"  the  "nectar  that  Jupiter  sips,"  and  the  "free  and 
pure  country  air,'*  is  quoted  as  proof  of  the  fact  that  the  coun- 
try keeps  itself  pure,  and  that  such  condition  is  sustained  by 
the  unaided  laws  of  nature.  Man  is  not  called  upon,  while  in 
the  country,  to  exert  any  care  as  regards  his  surroundings;  to 
be  in  the  country  is  to  be  where  health  abounds,  etc. 

Certainly,  this  view  is  all  wrong.  While  the  curses  accom- 
panying over-crowding  are  found  in  cities,  still,  as  in  other 
cases,  such  ills  have  compensating  blessings.  Men  are  found  in 
such  places  exerting  themselves,  and  providing  means  for  the 
removal  of  that  which  would  cause  sickness,  and  finally  drive 
them  from  that  location,  and  in  consequence  of  such  care  the 
centers  of  population  are  often  less  afflicted  with  preventable 
forms  of  disease  than  are  the  rural  districts,  for  in  the  latter,  a 
"  trnst  in  Providence"  system  prevails — an  apathy  born  of 
ignorance  and  sloth,  and  kept  up  by  false  teaching  and  penu- 
riousness,  permits  that  which  destroys  to  remain,  and  prevents 
the  needed  protective  influences  from  being  exerted. 

To  sustain  our  position  we  refer  to  the  accompanying  tables: 

3— Ed.  H. 


84 


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88 

Table  X  gives  by  State,  and  eaeb  i;ounry,  total  deaths  from 
all  causes.  The  deaths  from  each  of  the  ten  causes  iu  each 
county.  Also  tlie  per  cent,  of  the  mortality  from  each  cause 
of  death,  to  the  total  mortality  iu  the  several  counties. 

All  such  causes  of  death  are  in  a  great  degree  preventable. 
A  study  of  the  tables  will,  we  think,  show  tliat  these  prevent- 
able diseases  exist  in  a  greater  degree  in  the  rural  districts  and 
scattered  population  than  iu  those  counties  where  the  popula- 
tion is  more  concentrated;  whereas,  with  proper  attention  and 
such  care  as  Boards  of  Healtli  exert,  both  by  mandatory  en- 
forcement of  proper  rules  and  educational  functions. 

Scarcely  any  deaths  should  occur  in  these  counties  from  the 
causes  mentioned. 

In  this  table  there  is  included  in  the  estimate  of  total  mor- 
tality from  all  causes,  710  still-birth>2.  The  estinuited  per  cent, 
of  mortality  for  the  State  from  the  ten  specitied  causes  to  tlie 
total  mortality  is  exclusive  of  Porter,  Cass,  Wells  and  Starke 
counties,  the  Health  01ii(;ers  of  those  counties  having  made 
no  report. 

We  liud  the  mortality  from  those  ten  causes  to  be  4,149 — 
nearly  one-half  of  the  total  deaths  in  the  State,  if  we  exclude 
still-births.  This  is  a  bad  showing,  even  if  we  estimate  that 
one-half  of  such  deaths  might  be  [»re vented.  We  also  find 
that  the  death-rate  for  these  ten  causes  to  the  total  mortality 
iu  nine  counties  having  the  most  concentrated  population  is 
below  40  per  cent.,  while  in  twenty-nine  counties,  altogether 
agricultural,  with  population  less  concentrated,  the  death-rate 
exceeds  40  per  cent.  Such  fact  ought  at  once  to  settle  the  ques- 
tion as  to  the  need  of  some  means  being  used  in  the  rural  dis- 
tricts to  prevent  deaths  from  such  preventable  causes.  If  we 
consider  separately  each  of  these  ten  causes  of  death,  w*e  find 
that  in  the  counties  given  to  agriculture,  and  where  the  popu- 
lation is  most  scattered,  the  death-rate  from  nearly  all  these 
preventable  causes  exceed  that  which  is  found  to  exist  in  coun- 
ties with  population  more  concentrated. 

The  per  cent,  of  deaths  from  Diphtheria  iu  seven  counties  of 
scattered  population,  designated  as  (a,)  average  0.53  per  cent.; 
in  seven  counties  of  concentrated  jtopulation,  designated  as  (A), 
it  averaged  1.57  per  cent.  Deaths  from  whooping  cough  in 
seven  counties   [a]   averages    3.oM,   in   seven  counties  {h)   1.41. 


89 

Deaths  from  scarlet  fever  in  seven  counties  (a)  averaged  4.4<i 
per  cent.;  in  seven  counties  (/>)  1.41  per  cent. 

Deaths  from  typhoid  fever  in  seven  counties  (a)  3.20  per 
cent.;  in  seven  counties  (6)  3.20  per  cent.  Deaths  from  spot- 
ted fever  in  seven  counties  (a)  average  4.11  per  cent.;  in  seven 
counties  (6)  1.71.  Deaths  from  pneumonia  and  bronchitis 
(acute  hmg  affections)  in  seven  counties  (a),  25.60  per  cent.;  in 
seven  counties  (b),  7.66  per  cent.  Deaths  from  consumption  in 
seven  counties  (a)  average  17.74_per  cent.:  in  spi'^i.  r.^.-..^j-:--  /'^ 


jB:E<,:EiJ^rrJ^. 


On  pac^e  BS,  lines  11,  12  and  13,  should  read  as  follows: 
a  Both  by  mandatory  enforcement  of  proper  rules  and  edu- 
cational functions,  scarcely  any  deaths  should  occur  n.  these 
counties  from  the  causes  mentioned. 


„._^^v.   v.pun   iTie  lemaie  portion  of  the  population,  810  females 
dying,  to  531  males. 

*In  table  XI  is  given  the  deaths  from  each  of  the  ten  causes, 
by  ages,  and  the  total  number  of  deaths  from  each  cause.  W 
notice  that  404  deaths  occurred  from  these  ten  cause?  diy^g 
the  first  year  of  life,  a  greater  number  than  occurred!/*^  ^ny 
other  year.  This  preponderance  in  number  is  chie^  ^'^'e  to 
an  increase  of  deaths  from  whooping  cough,  spin9^^^'''"'^'Jgi- 
tis,  pneumonia  and  bronchitis.     Dividing  the  age/\   "*  P^nods 


of  ten  3'ears,  we  find  the  greatest  mortality  in^ 
— 1,100;   the  next  greatest  number  of  death 
agoa  of  25  and  30 — 833. 

No  death  from  whooping  cougu 


first 


pei-iod 


between   the 


the 


age  of  18 


o  deaths  from  scarlet  fever,  8  from  dipUna,  and  39  from 
small-pox  occurred  after  that  age,  while  lOjaths  from  wlioop- 
ing  cough,  64  from  scarlet  fever,  153  frorfiphtheria,  and  47 
from  small-pox  occurred  before  the  agd^l8.      Of  the  480 


/ 


*Table  omitted  here. 


88 

Tablo  X  gives  by  State,  and  each  I'ounty,  total  deaths  from 
all  causes.  The  deaths  from  each  of  the  ten  causes  iu  each 
county.  Also  tlie  pur  cent,  of  the  mortality  from  each  cause 
of  death,  to  the  total  mortality  iu  the  several  counties. 

All  such  causes  of  death  arc  in  a  great  degree  preventable. 
A  study  of  tlie  tables  will,  we  tliink,  show  that  these  pi'cvent- 
able  diseases  exist  in  a  greater  degree  iu  the  rural  districts  aud 
scattered  population  than  in  those  counties  where  the  popula- 
tion is  more  concentrated;  whereas,  with  proper  attention  and 
such  care  as  Boards  of  Health  exert,  bntl.   Ki'  i>,...^ri.nf.^ 


riiat  the  death-rate  for  these  ten  causes  to  the  total  mortality 
iu  nine  counties  having  the  most  concentrated  population  is 
below  40  per  cent.,  while  in  twenty-nine  counties,  altogether 
agricultural,  with  population  less  concentrated,  the  death-rate 
exceeds  4U  per  cent.  Such  fact  ought  at  once  to  settle  the  ques- 
tion as  to  tile  need  of  some  means  being  used,  in  the  rui'al  dis- 
tricts to  prevent  deaths  from  such  preventable  causes.  If  we 
consider  separately  each  of  these  ten  causes  of  death,  we  find 
that  in  the  counties  given  to  agriculture,  and  w  here  the  popu- 
lation is  most  scattered,  the  death-rate  from  nearly  all  these 
preventable  causes  exceed  that  which  is  found  to  exist  in  coun- 
ties witli  population  more  concentrated. 

The  per  cent,  of  deaths  from  Diphtheria  iu  seven  counties  of 
scattered  population,  designated  as  (a,)  average  fi.o3  per  cent.; 
in  seven  counties  of  concentrated  population,  designated  as  (A), 
it  averaged  1.57  per  cent.  Deaths  from  whooping  cough  in 
seven  counties   {a)   averages    ii.oV,   in   seven  counties  {b)   1.41. 


89 

Deaths  from  scarlet  fever  in  seven  counties  (n)  averaged  4.4B 
per  cent.;  in  seven  counties  (/?)  1.41  per  cent. 

Deaths  from  typhoid  fever  in  seven  counties  {a)  3.20  per 
cent.;  in  seven  counties  (6)  3.20  per  cent.  Deaths  from  spot- 
ted fever  in  seven  counties  (a)  average  4.11  per  cent.;  in  seven 
counties  (h)  1.71.  Deaths  from  pneumonia  and  bronchitis 
(acute  hiug  affections)  in  seven  counties  («),  25.60  per  cent.;  in 
seven  counties  (6),  7.66  per  cent.  Deaths  from  consumption  in 
seven  c©unties  (a)  average  17.74  per  cent.;  in  seven  counties  (6) 
12.21  per  cent.  Deaths  from  casualties  in  seven  counties  (a) 
average  7.09;  in  seven  counties  (6),  4.75  per  cent. 

*If  we  examine  tableXII  that  gives  deaths  by  occupation,  we 
find  that,  as, reported,  about  one-half  of  the  deaths  from  these 
ten  causes  occurred  among  those  we  must  class  as  farmers.  In 
this  classification  we  must  place  one-half  of  those  returned  as 
laborers,  housekeepers,  housewives,  domestics,  and  those  placed 
as  not  reported. 

Out  of  the  228  deaths  from  casualties,  80  were  classed  as 
farmers;  of  the  840  deaths  from  pneumonia  and  bronchitis,  439 
were  of  the  class  farmers;  of  the  340  deaths  from  typhoid 
fever,  169  were  farmers.  Of  deaths  by  consumption,  334  were 
of  the  tarmer  class.  This  cause  of  death  showed  its  greatest 
efi:ect  upon  the  female  portion  of  the  population,  810  females 
dying,  to  531  males. 

*In  table  XI  is  given  the  deaths  from  each  of  the  ten  causes, 
by  ages,  and  the  total  number  of  deaths  from  each  cause.  "W 
notice  that  404  deaths  occurred  from  these  ten  causes  du 
the  first  year  of  life,  a  greJiter  number  than  occurred  iri  any 
other  year.  This  preponderance  in  number  is  chie^r  due  to 
an  increase  of  deaths  from  whooping  cough,  spina^neningi- 
tis,  pneumonia  and  bronchitis.  Dividing  the  ages  into  periods 
of  ten  years,  we  tiiid  the  greatest  mortality  in  tbp  first  period 
— 1,100:  the  next  greatest  number  of  deaths  j^between  the 
agoa  nf  25  and  30— 833. 

No  death  from  whooping  cougn  occurs  :,/jj#  the  age  of  18 
5  deaths  from  scarlet  fever,  8  from  dipXtrftria,  and  39  from 
small-pox  occurred  after  that  age,  while  lO^ftaths  from  whoop- 
ing cough,  64  from  scarlet  fever,  153  from  diphtheria,  and  47 
from  small-pox  occurred  before  the  age  :>f  18.      Of  the  480 


♦Table  omitted  here. 


/ 


40 

(leathii  from  typhoid  tcver,  the  majority  occurred  hetwecn  the 
ages  of  teji  and  -jO;  from  this  cause  the  deaths  of  maU>s  and 
females  are  ahout  ecjual  in  numher.  Of  deaths  from  spotted 
fever,  there  were  '2'jU;  a  majority  (135)  occurred  hefore  the  age 
of  10  years.  More  deaths  occurred  from  consumption  than 
from  an\-  other  of  tlie  ten  rauses  (1.841),  and  next  to  this, 
})n(MinK)nia  (1,094).  I'nenmonia  and  hnmchitis.  comhined, 
shf)\v  1,286  deaths. 

Ol"  broncliitis,  a  majority  of  dcatlis  (105)  occurred  ix'fore  the 
age  of  live  years.  The  great(;st  age  at  which  death  occurred 
was  107  years.  Two  returns  at  this  age,  one  a  mahi,  the  cause 
of  death  not  being  ohl  age,  but  pneumonia,  and  one  a  female, 
death  from  old  age.  There  have  been  102  deaths  returned  and 
no  ages  given.  Age  is  an  important  item  in  these  statistics, 
and  sliould  be  returned  in  all  cases.  Deaths  from  early  old 
age  generally  have  some  additional  reason  for  their  apY)earance. 
and  care  should  be  taken  in  returning  facts  in  such  cases. 
Deaths  of  those  under  live  years  of  age  numl)er  21.19  per 
cent,  of  the  whole. 

It  can  not  fail  to  strike  the  attention  that  more  deaths  occur 
from  whooping  cough  than  from  scarlet  fever.  This  is  thought 
to  be  rather  a  harndess  disease,  at  least  considered  inevitable, 
and  the  sooner  the  child  has  it  the  better,  no  care  is  taken  of  the 
sufferer,  acute  <]isease  of  the  lungs  follows,  and  death  is  often 
tlii^  result.  The  people  need  to  be  educated  upon  this  subject, 
.ind  taught  that  proper  care  by  pai-ents  and  nurses  will  prevent 
a  V^rge  proportion  of  deaths  from  this  cause. 


■"LPLJC 


GAYLAMOUNT 

PAMPHLET  BINDER 


Manufactured  by 

[a^YLORD  BROS.  Inc. 

Syracuw,  N.Y. 

Stockton,  Collf . 


U.C.  BERKELEY  LIBRARIES 


CDET377ia3 


